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SITUASI PERAWAT PEGAWAI TIDAK TETAP DI DAERAH TERPENCIL PEGUNUNGAN MERATUS KABUPATEN HULU SUNGAI TENGAH – SEBUAH EVALUASI TERHADAP IMPLEMENTASI KEBIJAKAN Rahmatullah Laksono Trisnantoro Dwi Handono Sulistyo
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Background: The operation of mobile health center activitiesis currently unable to increase the coverage and provide equaldistribution of basic health service for people in isolated areas.The cost for mobile health center activities is relativelyhigh; it needs lots of staff and the service hours are limited. Asthe budget for mobile health center operation is limited, thefrequency of mobile health center activities is relatively low.Further consequence is that the implementation of survaillanceand priority program is constrained. To improve health servicefor people living in isolated areas of Meratus Mountain theDistrict Government of Hulu Sungai Tengah in 2002 issued apolicy on Non Permanent Staff Nurses. This policy is aimed toprovide continuous and accessible basic health service forthe community whenever they need it.Method: This was a descriptive qualitative study that used acase study design and was carried out at 4 villages that gotallocation of non permanent staff nurses with as many as 14informants. Primary data were obtained from indepth interviewwhereas secondary data were obtained from documentsearch particularly documents at Hulu Sungai Tengah districthealth office and health centers. Observation was also madeto get information not covered in indepth interview.Result: The result shows improvement in availability of basicservices to the community. On the other hand limited facilitiesare made available to the non permanent staff nurses, alongwith inadequate equipment, supplies, and vehicle to do theirwork. Also there is lack of additional incentive and regularmonitoring to support them.Conclusion: Basic health service was available more continuouslyand more accessible for people at isolated areas.However, findings also suggest that the policy of non permanentstaff nurses for isolated areas of Meratus Mountain, Districtof Hulu Sungai Tengah had not been fully supported bynecessary facilities, equipment, additional incentives and monitoring.Keywords: policy evalution, non permanent staff nurses, isolatedareas,

Potensi Diskresi Street Level Bureaucrat di Puskesmas dalam Implementasi Universal Health Coverage: Studi Kasus Puskesmas Krembangan Selatan, Surabaya Arif Priyo Nugroho
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 3 (2014)
Publisher : Center for Health Policy and Management

Background:Primary Health Centre may be described as street level bureaucracy that plays important role in implementing health services policy.The study aimed to analyze the threat of street level bureaucrat in Universal Health Coverage Implementation. Methods:Michael Lipsky theory of street level bureaucrat was usedto explain why Puksesmas takes central role in health policy implementation. This case study was conducted in South Krembangan, Surabaya. Observation and secondary data analysis are the main tools to identify the daily pattern of mismatch between goals and implementation, which referred to as street level bureaucrat discretion in the implementation of policy. Results:The findings showed that there were negative discretion in implementing policy caused by over workload in providing health services. Such problems were caused by problems in human resources management and insufficiency of infrastructure. Conclusion:Insufficient resources in Puskemaspotentially trigger medical staffs to make negative discretion in theUniversal Health Coverage implementation. Latar Belakang:Puskesmas dapat dikatakan sebagai street level bureaucracy yang mempunyai peran penting pelaksanaan kebijakan pelayanan kesehatan. Studi ini bertujuan untuk menganalisis peluang ancaman dari street level bureaucrat dalam upaya implementasiUniversal Health Coverage. Metode:Kami menggunakan teori Michael Lipsky tentang street level bureaucrat untuk menjelaskan mengapa puskesmas memiliki peran penting dalam pelaksanaan kebijakan kesehatan. Studi kasus ini dilakukan di Krembangan Selatan, Surabaya. Observasi dan analisis data sekunder adalah alat utama untuk mengetahui pola sehari-hari ketidakselarasan antara tujuan dan pelaksanaan yang disebut sebagai diskresi dalam implementasi kebijakan. Hasil:Penelitian ini menemukan bahwa ada ancaman diskresi negatif dalam melakukanimplementasi kebijakandikarenakan oleh kelebihan beban kerja dalam melakukan kewajiban pelayanan kesehatan. Hal tersebut disebabkan oleh permasalahan mengenai pengelolaan sumber daya manusia dan infrastrtuktur yang kurang memadahi. Kesimpulan: Kurang memadainya sumber daya di puskesmas, berpotensi memicu staff medis melakukan diskresi negatif dalam Implementasi Universal Health Coverage.

Pelaksanaan Kebijakan DAK Non Fisik Bidang Kesehatan untuk Tenaga Kontrak Promosi Kesehatan di Kabupaten Sumbawa dan Kabupaten Sleman Tahun 2016 Yuniati Yuniati; Laksono Trisnantoro; Dwi Handono Sulistyo
Jurnal Kebijakan Kesehatan Indonesia Vol 6, No 3 (2017)
Publisher : Center for Health Policy and Management

ABSTRACTBackground : In order to support the global commitment in addressing the burden of non-communicable diseases, the government through the Ministry of Health set the one of the targets of the National Development Strategy Plan is the promotion and preventive service through the availability of health promotion personnel at the Puskesmas. To meet these needs the government issued a policy that is the Regulation of the Minister of Health No. 82 of 2015 on Technical Guidance Special Allocation Fund for Health Operational Support where one of financing is for promotive and preventive activities directed to finance one (1) contract health promotion workers. Aims : To analyze the implementation of the policy of Non-Physical Special Allocation Fund of 2016 to recruit Health Promotion Contract Workers for Puskesmas in Sumbawa and Sleman districts. Methods : A single case study study was established using Implementation Research carried out at the Health Office in Sumbawa and Sleman districts. Informants were interviewed using the Consolidated for Implementation Research (CFIR) framework as a guide in collecting and analyzing qualitative data. Result :The most dominant factor of CFIRs affecting the implementation of contract labor policies is the internal communication network, particularly the involvement of the management. Organizational needs are the reasons for implementing a policy, but this is not a major factor in the implementation of a policy. Meeting the needs of the organization is influenced by the involvement factor of the leader of the organization in this case the leadership commitment to the vision of the organization, the implementation is also influenced by the external communication network organization that is: advocacy, coordination and cooperation with cross-related sector. Conclusion : The policy of recruitment of contract workers in Sleman district was successfully implemented because the policy makers and implementers played a good role, while Sumbawa regency did not implement this policy because of the difference perception about the need of health promotion personnel between Puskesmas as implementer of policy and health department as policy maker which supervises the Puskesmas. Keyword : Implementation, outcome, DAK non-Physical policy, Contract force health promotion, Consolidated Framework for Implementation ResearchABSTRAKLatar belakang: Isu global tentang beban penyakit tidak menular menjadi salah satu dasar kebijakan nasional di bidang kesehatan. Penyakit tidak menular adalah penyebab 68% kematian di dunia dan sebagian terjadi pada negara berpenghasilan menengah ke bawah. Dalam rangka mendukung komitmen global pemerintah melalui Kementerian Kesehatan menetapkan salah satu sasaran Rencana Strategi Pembangunan Nasional (RPJMN) adalah upaya pelayanan promotif dan preventif dalam rangka menurunkan kejadian penyakit tidak menular yang dalam beberapa tahun terakhir berkembang pesat. Untuk memenuhi kebutuhan tersebut pemerintah melalui Kementerian Kesehatan mengeluarkan kebijakan yaitu Peraturan Menteri Kesehatan Nomor 82 Tahun 2015 tentang Juknis Dana Alokasi Khusus sebagai Bantuan Operasional Kesehatan dimana salah satu pembiayaannya adalah untuk kegiatan promotif dan preventif yang diarahkan untuk membiayai satu (1) orang tenaga kontrak promosi kesehatan. Tujuan untuk menganalisis pelaksanaan kebijakan Dana Alokasi Khusus Non Fisik Tahun 2016 untuk merekrut Tenaga Kontrak Promosi Kesehatan di Kabupaten Sumbawa dan Kabupaten Sleman Metode: Penelitian studi kasus tunggal terjalin dengan strategi pendekatan menggunakan Riset Implementasi ini dilakukan di Dinas Kesehatan di Kabupaten Sumbawa yang belum melaksanakan kebijakan Tenaga Kontrak Promosi Kesehatan dan Kabupaten Sleman yang telah melaksanakanya. Informan diwawancarai dengan menggunakan kerangka kerja The Consolidated for Implementation Research (CFIR) sebagai panduan dalam pengumpulan dan analisis data kualitatif. Partisipasi aktif pembuat keputusan kebijakan baik di Pusat maupun di Daerah ikut dilibatkan selama proses penelitian berlangsung, mulai dari penentuan topik, pertanyaan penelitian sampai pada pelaksanaan penelitian. Kata kunci: Implementasi, outcome, kebijakan DAK non Fisik, Tenaga Kontrak promosi kesehatan,Consolidated Framework for Implementation Research

Kebutuhan dan Perencanaan Tenaga Kesehatan di Provinsi Sumatera Utara Heru Santosa
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 1 (2015)
Publisher : Center for Health Policy and Management

Background: The health sector planning process regarding facilities, infrastructure and health work force is a planning document that contains information and data health development programs that will be implemented by the government. Thus the results of the study are expected to become the master development plan document for health sector in infrastructures and facilities as well as health professionals. This study was conducted to describe the supply of health personnel or whether the target has been reached, to calculate the need of health work force according to the number, types and qualifications, and to formulate policy regarding the needs of health work forcein North Sumatera Province. Methods: Methods for estimating health manpower needs was determined by the ratio method. The use of this method is based on the data and goal of study by focusing on the achievement so far and by comparing the ratio of the target. Results: Compared to 2010, the average estimated needs of health workers in 2015 was twice as much. This is a challenge that needs to get attention. It was caused by the limited budget to support recruitment and procurement. The results of the study also found that some types of health personnel were “rare” such as health analysts, speech therapists, refractionists optician, physio therapist, radiographer, epidemiology, and health planners.Conclusion: The empowerment program and the utilization of available health personnel with the addition of sufficient incentives was certainly more efficient than recruitment or procurement of new personnel, although the number of health professionals still should be added gradually every year. Latar Belakang: Upaya penyusunan perencanaan sektor ke- sehatan bidang sarana dan prasarana dengan tenaga kese- hatan merupakan dokumen perencanaan yang bersifat indikatif yang memuat informasi dan data program-program pemba- ngunan kesehatan yang akan dilaksanakan langsung oleh Pe- merintah. Dengan demikian hasil kajian diharapkan sebagai dokumen perencanaan induk pembangunan sektor kesehatan bidang prasarana dan sarana serta sumber daya tenaga kese- hatan. Mendasarkan hal tersebut maka kajian ini dilakukan untuk menggambarkan pencapaian atau penyediaan tenaga kese- hatan, menghitung kebutuhan tenaga kesehatan menurut jumlah, jenis dan kualifikasi dan merumuskan kebutuhan kebijakan perencanaan tenaga kesehatan di Provinsi Sumatera Utara. Metode:Metode penyusunan kebutuhan tenaga kesehatan ditentukan dengan metode rasio (Ratios Method). Penggunaan metode ini mendasarkan kepada data dan tujuan kajian yang lebih mengutamakan pencapaian dengan membandingkan terhadap rasio sebagai sasaran. Hasil: Dibandingkan tahun 2010, maka perkiraan rata-rata kebutuhan tenaga kesehatan pada tahun 2015 sebanyak dua kali lipatnya. Tentunya suatu tantangan yang perlu mendapatkan perhatiannya. Hal ini disebabkan oleh keterbatasan dukungan anggaran untuk melakukan rekruitmen dan pengadaan tenaga kesehatan secara berlebihan. Hasil kajian juga menemukan beberapa jenis tenaga kesehatan yang ”langka” seperti analis kesehatan, terapis wicara, refraksionis optisien, fisioterapis, radiographer, epidemiologi, dan ahli perencana kesehatan. Conclusion:Program pemberdayaan dan pendayagunaan tenaga kesehatan yang ada dengan penambahan insentif yang cukup tentunya lebih efisien bila dibandingkan rekruitmen atau pengadaan tenaga baru, walaupun secara bertahap tetap harus dilakukan penambahan setiap tahunnya.

Evaluasi Koordinasi Pelayanan Kesehatan Lintas Provinsi pada Masa Tanggap Darurat Bencana Gunung Merapi Tahun 2010 Sri Purwaningsih; Laksono Trisnantoro; Bella Donna
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 1 (2014)
Publisher : Center for Health Policy and Management

Background: Natural disasters influence human health and prosperity. The increasing tendency for natural disaster has become a priority in the disaster management in Indonesia. Gunung Merapi erupted on October 26, 2010. The eruption continued until November 2010. The disaster led to huge life tolls and injuries. It also caused substantial and extensive dam- ages and losses in four main regions, Sleman Regency in the Province of DI Yogyakarta, Magelang, Klaten, and Boyolali Regencies in the Province of Central Java. The data issued on December 13, 2010 reported 388 life tolls, 2.786 inpatient inju- ries, 62.923 outpatients injuries, and up to 21.338 refugees. To anticipate the spread of negative effects on the victim health due to Gunung Merapi eruption, the Provincial Health Office of DIY and Central Java had cross-provincial coordination, orga- nization, communication, and leadership.Method: A qualitative research was conducted using case study design. Subjects of the study were informants who played important roles in the coordinative process in the Prov- ince of DI Yogyakarta and Central Java. The data were col- lected by means of document investigation, direct observa- tion, and in-depth interviews. Data validity was checked by means of source, method, and data triangulation. Results: To realize an effective and efficient healthcare dur- ing the emergency response period after Gunung Merapi erup- tion, an integrated command organization was established to involve the two provinces – DI Yogyakarta and Central Java. The organization had daily coordination meetings by means of direct communication in terms of meetings and indirect com- munication using teleconference. Information could be received and transmitted quickly by means of sms gateway and email. Leadership applied during the emergency response period was command in nature, rather than authoritarian style. Conclusion: Cross-provincial healthcare coordination during the emergency response period after Gunung Merapi eruption in 2010 worked in a sufficiently effective way, since no ex- traordinary cases occurred at that time. Latar Belakang: Bencana alam selalu mempengaruhi kesehat- an dan kesejahteraan manusia. Bencana alam yang terus meningkat telah menjadi sebuah prioritas penanganan bencana di Indonesia. Pada tanggal 26 Oktober 2010, Gunung Merapi mengalami erupsi dan berlanjut sampai dengan awal Novem- ber 2010. Jumlah korban yang meninggal maupun luka-luka cukup banyak, serta menyebabkan kerusakan dan kerugian yang meluas di empat wilayah yaitu kabupaten Sleman di Provinsi DI Yogyakarta, Kabupaten Magelang, Klaten dan Boyolali di Provinsi Jawa Tengah. Informasi yang diperoleh pada tanggal 13 Desember 2010, data meninggal dunia 388 orang, rawat inap sejumlah 2.786 orang, rawat jalan 62.923 orang dan jumlah pengungsi sampai 21.338 orang. Untuk mengantisipasi meluasnya dampak negatif terhadap kesehatan yang ditimbulkan akibat erupsi Gunung Merapi, Dinas Kesehatan Provinsi DIY dan Jateng melaksanakan koordinasi, pengorgani- sasian, komunikasi dan kepemimpinan. Metode Penelitian: Penelitian kualitatif dengan rancangan studi kasus. Subyek penelitian adalah informan yang memiliki peranan penting dalam proses koodinasi di Provinsi D.I. Yog- yakarta dan Jateng. Pengumpulan data menggunakan studi dokumentasi, observasi langsung, dan wawancara mendalam. Validitas data menggunakan triangulasi sumber, metode, dan data.Hasil Penelitian: Untuk mencapai pelayanan kesehatan yang efektif dan efisien pada masa tanggap darurat bencana Gunung Merapi, dibentuk organisasi komando terpadu yang melibatkan dua Provinsi yaitu DI. Yogyakarta dan Jateng, melaksanakan koordinasi melalui rapat harian menggunakan komunikasi langsung dengan pertemuan dan tidak langsung dengan tele- conference. Penerimaan dan pengiriman informasi cepat melalui sms gateway dan email. Gaya Kepemimpinan yang diterapkan pada masa tanggap darurat bersifat komando dan tidak otoriter. Kesimpulan: Koordinasi pelayanan kesehatan lintas provinsi pada masa tanggap darurat Gunung Merapi tahun 2010 berjalan cukup efektif, karena pada saat itu tidak terjadi kasus KLB.

Persepsi Bidan Praktek Mandiri terhadap Paket Persalinan Badan Penyelenggara Jaminan Sosial (BPJS) dalam Keberlanjutan Kerjasama menjadi Provider dalam Jejaring Dokter Keluarga di Kota Bengkulu Siti Solekah; Mohammad Hakimi; Mora Claramita
Jurnal Kebijakan Kesehatan Indonesia Vol 6, No 1 (2017)
Publisher : Center for Health Policy and Management

ABSTRACTBackground: Maternal deaths as a global public health problem and urgent to be addressed through the launch of the Safe Motherhood program. UN Resolution on universal health coverage (Universal Health Coverage) is an important resolution and urged all countries to develop a health system with equitable access and affordable cost. This is one of the programs to reduce MMR and IMR. Based on research in three countries, namely Burkina Faso, Ghana and Tanzania also had a strong effort to improve the quality of maternal and neonatal health (MNH) In addition, these three countries are also striving to improve the performance and motivation of the provider. In Indonesia, according to Ministry of Health Decree No. 59 Year 2014 About the standard of health care, require midwives in cooperation with BPJS through a network of family doctors who have been appointed to make the deal as one of the Government's aim to improve maternal and child health (MCH).Methods: This study is a qualitative research design of phenomenology. Data collection is carried out by the method of in depth review or directly using the guidelines of unstructured interviews, and open questions midwives practice independently as a unit of analysis. Samples or informants taken up to a certain saturation or have reached sufficient number until there is no more data that needs to be explored. Triangulation of data include interview with the chairman of the Indonesian Midwives Association (IBI). Midwife verifiers and family doctor.Results: The results showed that midwives have a bad perception of the delivery package BPJS today. The reason is partly that the mechanism of the claims made package, complicated claim procedures and disbursement process long and low birth rates. So the motivation BPM in cooperation with the current BPJS is relatively small. The phenomenon that researchers have found that there are several midwife, although still tied to cooperation with BPJS but not serving patients with BPJS. Other phenomena that is the BPM want to directly contracted by with BPJS without a network of family doctors. This is due to lack of socialization of BPJS for strengthening primary care program that is currently being initiated by the government.Conclusions: The perception of Independent Midwife Practice against BPJS delivery package is still bad. Although the objective of the government is quite good, but there is still need for evaluation and dissemination as an effort to strengthen the primary care for BPM in the sustainability of cooperation in networks of family doctors in the hope that the package delivery mechanism is not paid in package and increase of the delivery service tarif rates between 800 thousand to 1.5 million IDR. Keywords: Independent Midwife Practice, Delivery Package, BPJS ABSTRAKLatar Belakang: Kematian ibu sebagai masalah kesehatan masyarakat global dan mendesak untuk segera ditanggulangi melalui peluncuran program Safe Motherhood. Resolusi PBB pada cakupan kesehatan universal (Universal Health Coverage) pada bulan desember 2012, yang menggaris bawahi bahwa UHC merupakan resolusi yang penting dan mendesak pada semua negara untuk mengembangkan system kesehatan dengan akses yang adil dan biaya yang terjangkau. Hal ini merupakan salah satu program untuk menurunkan AKI dan AKB. Berdasarkan penelitian di tiga Negara yaitu Burkina Faso, Ghana dan Tanzania juga memiliki upaya yang kuat untuk meningkatkan kualitas kesehatan ibu dan bayi (MNH) Selain itu ketiga negara tersebut juga berjuang untuk meningkatkan kinerja dan motivasi para provider. Di Indonesia, berdasarkan Keputusan Menteri Kesehatan Nomor 59 Tahun 2014 Tentang standar pelayanan kesehatan, mewajibkan para bidan bekerjasama dengan BPJS melalui jejaring dokter keluarga yang telah ditunjuk untuk membuat kesepakatan sebagai salah satu tujuan pemerintah untuk meningkatkan pelayanan kesehatan ibu dan anak (KIA).Metode: Penelitian ini merupakan penelitian kualitatif dengan rancangan fenomenologi,. Pengambilan data dilaksanakan dengan metode wawancara mendalam secara langsung menggunakan pedoman wawancara tidak terstruktur, dan pertanyaan terbuka kepada para bidan praktek mandiri sebagai unit analisis. Sampel atau informan di ambil sampai dengan saturasi tertentu atau telah mencapai kecukupan hingga tidak ada lagi data yang perlu digali. Sebagai triangulasi yang dipilih antara lain ketua IBI, Bidan Koordinator/verifikator dasar dan Dokter keluarga.Hasil: Dari hasil penelitian menunjukkan bahwa para bidan memiliki persepsi yang buruk terhadap paket persalinan BPJS saat ini. Meskipun jumlah paketnya lebih besar dari Jampersal, namun tidak semua paket bisa diklaimkan. Penyebabnya antara lain yaitu mekanisme klaim yang dibuat perpaket, prosedur klaimnya rumit dan proses pencairannya lama serta rendahnya tarif persalinan. Sehingga motivasi Bidan Praktek Mandiri (BPM) didalam kerjasama dengan BPJS saat ini relatif kurang. Fenomena yang peneliti temukan yaitu ada beberapa bidan yang meskipun masih terikat kerjasama dengan BPJS tetapi tidak melayani pasien persalinan dengan BPJS. Hal ini terkait dengan rumitnya prosedur paket persalinan BPJS sehingga bidan enggan untuk mengklaim ke BPJS. Fenomena lainnya yaitu para BPM ingin bisa langsung bekerjasama dengan BPJS tanpa melalui jejaring dokter keluarga. Hal ini akibat kurangnya sosialisasi dari BPJS untuk program penguatan layanan primer yang saat ini sedang dicanangkan oleh pemerintah.Kesimpulan: Persepsi Bidan Praktek Mandiri terhadap paket persalinan BPJS masih buruk. Untuk keberlanjutan menjadi provider di dalam jejaring dokter keluarga para BPM masih ingin tetap melanjutkan namun dengan harapan agar mekanisme paket persalinan tidak di buat perpaket dan ada peningkatan tarif persalinan antara 800 ribu sampai 1.5 juta rupiah. Kata Kunci: Persepsi, Bidan Praktek Mandiri, Paket Persalinan, BPJS

Evaluasi Pembentukan dan Pelatihan Kelompok Pendukung ASI di Desa Mekargalih dan Cipacing Kecamatan Jatinangor Kabupaten Sumedang Sri Astuti; Tina Dewi Judistiani; Ari Indra Susanti1
Jurnal Kebijakan Kesehatan Indonesia Vol 5, No 2 (2016)
Publisher : Center for Health Policy and Management

ABSTRACTIntroduction: General health survey in Indonesia reported that in 2010 only around 15.3% mothers gave exclusive breastfeeding. This number was steadily decreasing when reaching district level. This led to increased prevalence of malnutrition until 11.7% among children under 6 months old that in the future will play a role in increasing children mortality rate. The objective of this study was to give counseling and training for breastfeeding support group and evaluate its impact on their knowledge regarding breastfeeding in Mekargalih and Cipacing Village, Jatinangor District, Sumedang Regency.Methods: Questionnaire regarding knowledge of breastfeeding was used prior to counseling and training among 100 mothers selected with purposive sampling. After counseling and training, knowledge was evaluated again using another questionnaire. Additional evaluation for breastfeeding support group was gained through in-depth interview.Result: There was significant increase of knowledge (p<0.05) after counseling and training for breastfeeding support group. Conclusion: Counseling and training for breastfeeding support group could provide better knowledge to encourage mothers to do exclusive breastfeeding. Keywords: exclusive breastfeeding, knowledge, support group ABSTRAKLatar Belakang: Survei kesehatan (Riskesdas) di tahun 2010 melaporkan bahwa hanya sekitar 15,3% ibu di Indonesia yang melakukan pemberian ASI eksklusif. Pada tahun 2013, ASI eksklusif dilakukan oleh 25,4% ibu di wilayah Jawa Barat. Angka ini semakin menurun terutama di tingkat kecamatan. Hal ini berperan dalam peningkatan prevalensi giz iburuk pada anak- anak di bawah 6 bulan yang akhirnya akan berdampak pada peningkatan angka kematian anak. Maka dari itu penelitian ini bertujuan untuk mengevaluasi pengetahuan dan pemberian ASI kelompok pendukung ASI yang dihasilkan dari pembentukan dan pelatihan terhadap kelompok pendukung ASI di Desa Mekargalih dan Cipacing, Kecamatan Jatinangor kabupaten SumedangMetode: Pengetahuan tentang pemberian ASI dari 100 orang dinilai menggunakan kuesioner selanjutnya para ibu diberikan pelatihan pemberian ASI serta pembentukan Kelompok Pendukung ASI (KP-ASI). Perubahan pengetahuan dinilai kembali menggunakan kuesioner. Evaluasi kelompok Pendukung ASI dalam menyusui dan menilai pelaksanaan pelatihan dalam menyiapkan kelompok pendukung ASI untuk menjadi fasilitator teman sebaya melalui wawacara mendalamHasil: Terdapat peningkatan yang signifikan pada pengetahuan (p<0.05) sebelum dan sesudah pelatihan dan pembentukan KP –ASI.Kesimpulan: Pembentukan dan pelatihan KP-ASI sangat mendukung untu mendorong para ibu melakukan pemberian ASI eksklusif. Kata kunci: ASI eksklusif, pengetahuan, KP-ASI

Gambaran Pelaksanaan Pelayanan BPJS Kesehatan di Fasilitas Kesehatan Tingkat Pertama di Kota Semarang Suryani Yuliyanti; Ratnawati Ratnawati
Jurnal Kebijakan Kesehatan Indonesia Vol 5, No 1 (2016)
Publisher : Center for Health Policy and Management

Latar Belakang: Pelaksanaan program Jaminan Kesehatan Nasional (JKN) oleh pemerintah merupakan amanat UU Nomor 40 tahun 2004 Tentang Sistem Jaminan Sosial Nasional, pada tahun 2011 terbit UU Nomor 24 Tentang Badan Penyelenggara Jaminan Sosial (BPJS) selanjutnya BPJS merupakan badan penyelenggara program JKN yang mulai dilaksanakan sejak Januari 2014. Dalam peraturan BPJS fasilitas kesehatan tingkat pertama merupakan ujung tombak pelayanan kesehatan. Pelayanan FKTP seharusnya mengutamakan Preventif dan Promotif tanpa melupakan kuratif dan rehabilitatif. Penelitian ini bertujuan untuk menggambarkan pelaksanaan layanan BPJS di Fasilitas kesehatan tingkat 1. Metode: Penelitian deskriptif terhadap cakupan dan pemanfaatan layanan yang tersedia di fasilitas kesehatan tingkat 1. Pengumpulan data selama bulan Januari 2015 dilakukan dengan observasi dan wawancara pada 100 pasien dan 20 dokter di fasilitas kesehatan tingkat 1. Hasil: Data yang diperoleh dari FKTP, dokter menyatakan bahwa rata – rata kunjungan pasien 10-50 orang perhari, cakupan layanan yang diberikan memenuhi aturan BPJS yaitu meliputi pemberian layanan pengobatan, preventif, promotif dan rehabilitatif. Pelayanan yang masih kurang optimal diantaranya masih terdapat 5 Faskes yang belum memberikan layanan imunisasi, layanan KB belum mencakup MKJP, dan pelayanan home care yang tidak dilaksanakan secara maksinal. Kendala yang dirasakan sulitnya prosedur layanan BPJS akibat sosialisasi yang kurang bagi pasien dan Faskes menimbulkan kesalahpahaman baik antara pasien dengan Faskes maupun antara FKTP dengan Faskes tingkat 2. Pasien mengeluh obat yang diperoleh berbeda merk, pelayanan yang kurang memuaskan, Meski demikian 100% persen responden dokter dan Pasien menyatakan bahwa BPJS bermanfaat, yaitu biaya kesehatan menjadi lebih murah. Penyakit kronis menjadi lebih terkontrol, kompetensi dokter lebih meningkat dengan adanya program pelatihan yang dilaksanakan oleh BPJS, adanya rujukan balik sebagai proses evaluasi layanan yang diberikan FKTP. Sehingga berdasarkan hasil penelitian disimpulkan bahwa pelaksanaan layanan BPJS di Semarang sesuai ketentuan dan memberikan manfaat baik bagi pasien maupun bagi dokter meskipun masih perlu perbaikan pada program preventive dan promotif. Background. Implementation of the National Health Insurance program (JKN) by the government is mandated by Law No. 40 of 2004 on National Social Security System. In 2011 the government published Law No. 24 about the Badan Penyelenggara Jaminan Sosial (BPJS) hereinafter BPJS. BPJS is an organization who implement the JKN program that started since January 2014. BPJS at primary health facilities is an important component of health care that should give priority to preventive and promotive without forgetting curative and rehabilitative. This study aims to describe the implementation BPJS services at primary health facilities. Method. Descriptive study on the coverage and utilization of primary health facility service. Data collection at January 2015 is done by observation and interviews on 100 patients and 20 doctors at the primary health facility. Results. Data obtained from primary health facility, average of patient visits is 10-50 people per day, the availability of services is accordance with the BPJS rule, but need improvement on immunization, family planning and home care service. Obstacles of BPJS program is the lack of procedure and rule information, that cause misunderstandings between patients and doctor. Patient complain that they receive difference medicine, and the bad service when they use BPJS. Nevertheless physician and patient agree that BPJS make the health costing affordable, especially in chronical diseases. It increases medical personnel competencies through training program from BPJS and patient referral system. So the conclusion is implementation of health program from BPJS in Semarang is accordance with the rule, and give many benefits in health service. However it needs improvement in preventive and promotive service.

Konsumsi Rokok Rumah Tangga Miskin di Indonesia dan Penyusunan Agenda Kebijakannya Chriswardani Suryawati; Lucia Ratna Kartikawulan; Ki Haryadi
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 2 (2012)
Publisher : Center for Health Policy and Management

Background: The number of smokers in Indonesia is ranked third in the world and the highest in ASEAN. The estimated number of deaths due to smoke from the 2004 Susenas data was 399,800 people equivalent to total economic loss of IDR 154.84 trillion (U.S. $ 17.2 billion), or 4.5 times as much as the tax equivalents in 2005 (IDR 32.6 trillion). Indonesia has not yet ratified the Framework Convention on Tobacco Control (FCTC) but has issued various regulations related to tobacco control and the dangers of smoking. Cigarette consumption by poor households is high enough. This affects not only the consumption patterns of the households but also the health of the family. Objective: To obtain a description of poor households’health cost burden, patterns and factors that affect cigarette consumption by poor households in Indonesia in 2007 and to set the agenda of public health protection policies of the dangers of smoking. Methods: The data used were the secondary data from the study of the Indonesia Family Life Survey (IFLS) conducted in 2007 covering 13 provinces, 13,995 households and 50,580 individual samples. Results and Discussion: A total of 35.71% of poor households had a habit of smoking, and the types of cigarettes were factory-made cigarettes and home-made cigarettes (81.81% and 29.19%, respectively). The average cigarettes consumed were 9.72 bars per day. The average age of initiating to smoke was 18.89 years and 93.20% of poor households were still smoking up to this survey. Compared to the total expenditure of poor households, the average expenditure of cigarettes a month was IDR 86,496.96 (13.13%), while health expenditure was only IDR 7,440.87 (1.13%). The low expenditure on health, among others, were due to the presence of Jamkesmas that covered 51.48%. Cigarette demand model with multiple regression analysis showed that the price of cigarettes, per capita expenditure, food expenditure, and the age of initial smoking affected cigarette consumption. Conclusions and suggestions: To make the policy of public protection on the dangers of smoking effective, the government should immediately formulate policy agendas: 1) increase cigarette tax as high as 50% of the price of cigarettes, 2) regulate restrictions on smoking areas in public places, 3) promote and campaign the dangers of smoking to health, especially for adolescents, including restrictionson cigarette advertising on various media 4) continue policy for cigarette tax revenue in all regions and increase allocation of funds for health, 5) facilitate the development of nicotine replacement treatments and make people easier to get the products, and 6) initiate to develop a Jamkesmas discourse that requires the poor households to maintain their health care such as not to smoke. It needs to further develop the understanding on public protection policy agenda against the dangers of smoking that consists of perceiving public problem, defining the problem and raising support for making this public issue become the the government agenda. Latar Belakang: Jumlah perokok di Indonesia menduduki peringkat tiga terbesar di dunia dan tertinggi di ASEAN. Estimasi jumlah kematian karena merokok dari data Susenas 2004 sebesar 399.800 orang setara dengan total economic loss sebesar Rp 154,84 trilyun (US$ 17.2 milyar) atau setara 4.5 kali lipat cukai tahun 2005 (Rp 32,6 triliun). Indonesia belum meratifikasi Framework Convention on Tobacco Control (FCTC) tetapi di Indonesia telah terbit berbagai peraturan terkait pengendalian tembakau dan bahaya merokok. Konsumsi rokok Rumah Tangga (RT) miskin cukup tinggi. Hal ini tidak hanya berpengaruh pada pola konsumsi RT tetapi juga kesehatan keluarga. Tujuannya adalah memperoleh deskripsi beban biaya kesehatan RT miskin, pola dan faktor yang berpengaruh pada konsumsi rokok RT miskin di Indonesia tahun 2007 dan menyusun agenda kebijakan perlindungan kesehatan masyarakat dari bahaya rokok. Metode: merupakan data sekunder dari penelitian Indonesia Family Life Survei (IFLS) yang dilaksanakan tahun 2007 mencakup 13 propinsi, 13.995 RT dan 50.580 sampel individu. Hasil dan diskusi : Sebanyak 35,71% RT miskin mempunyai kebiasan merokok, terbanyak sigaret (81,81%) dan rokok ramuan sendiri (29,19%). Rerata perhari 9,72 batang rokok, usia pertama kali merokok rata-rata 18,89 tahun dan 93,20% RT miskin masih merokok sampai survei dilakukan. Dibandingkan pengeluaran total RT miskin, rerata pengeluaran rokok sebulan Rp. 86.496,96 (13,13%) sedangkan pengeluaran kesehatan hanya Rp.7.440,87 (1,13%). Kecilnya pengeluaran kesehatan antara lain disebabkan adanya Jamkesmas yang mencakup 51,48%. Model demand rokok dengan analisis regresi berganda menunjukkan bahwa harga rokok, pengeluaran per kapita, pengeluaran pangan, umur awal merokok mempengaruhi konsumsi rokok. Kesimpulan dan saran: Untuk mengefektifkan kebijakan perlindungan masyarakat dari bahaya rokok maka pemerintah harus segera menyusun agenda kebijakan: 1). kenaikan cukai rokok karena cukai mencapai 50% dari harga jual rokok, 2). peraturan pembatasan area merokok di tempat-tempat umum, 3). promosi dan kampanye bahaya merokok terhadap kesehatan terutama untuk remaja termasuk pembatasan iklan rokok pada berbagai media 4). melanjutkan kebijakan bagi hasil cukai rokok pada semua daerah dan meningkatkan alokasi dananya untuk bidang kesehatan, 5) memfasilitasi pengembangan dan mem permudah mendapatkan produk nicotine replacement treatments 6). mulai mengembangkan wacana Jamkesmas yang mensyaratkan upaya RT miskin ikut menjaga kesehatannya antara lain tidak merokok. Perlu lebih mengembangkan pemahaman akan agenda kebijakan perlindungan masyarakat terhadap bahaya merokok yang terdiri dari persepsi masalah publik, pendefinisian masalah dan penggalangan dukungan untuk menjadikan isu publik menjadi agenda pemerintah.

PROBLEM DAN TANTANGAN PUSKESMAS DAN RUMAH SAKIT UMUM DAERAH DALAM MENDUKUNG SISTEM RUJUKAN MATERNAL DI KABUPATEN KARIMUN PROVINSI KEPRI TAHUN 2012 Zulhadi Laksono Trisnantoro Siti Noor Zaenab
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Background: Strengthening referral system is a method toaccelerate decrease of maternal mortality rate. The main factorsaffecting referral system are facilities, staff, team work, andbudget that need seroius attention from all stakeholdersinvolved in the program of maternal health. By strengtheningthe system of maternal health the problem and the challenge ofhealth center to support of maternal referral can be addressed.Objective: The study aimed to evaluate referral system ofmaternal health at District of Karimun Province of KepulauanRiau.Method: This was a qualitative case study undertaken atKarimun Hospital and 2 health centers with high maternal andinfant mortality rate, i.e. Meral and Moro Health Center thatwere located at both urban and rural areas. Data were obtainedthrough in-depth interview, focus group discussion,observation, checklist and document study.Result: The result of the study showed there was limitation ofresources at primary health service such as facilities andequipments and hospital limited ability to provide comprehensiveemergency neonatal and obstetric management despite beingoperated 24 hours. There were lack of team coordicationacross referral levels involving district health office, hospitaland health centers, incomplete standard operating procedures,weak information system and bypassing referral procedure.Community participation in referral system was very highthough some labor was assisted by traditional childbirthattendants. This condition was mainly due to cultural factors/reasons.Conclusion: There are some problems and challenges in bothprimary health service and hospitals to support maternalreferral system in Karimun District. Some policies are requiredas a first step toward better referral system in Karimun District,for instance accelerating a functioning CMOC hospital,strengthening the teamwork across referral system, andestablishing SOP for maternal cases including its referralprocedures.Keywords: Problem, Challenge, Maternal referral system,Health Center, Distric Goverment Hospital.

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Home Page

OAI Link

Editorial Team

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Reviewer

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Contact Name Shita Dewi

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Journal Mail Official jkki.fk@ugm.ac.id

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Location Kab. sleman, Daerah istimewa yogyakarta INDONESIA

Abstract

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Abstract

Contact Name
Shita Dewi

Contact Email
-

Phone
-

Journal Mail Official
jkki.fk@ugm.ac.id

Editorial Address
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Location
Kab. sleman,

Daerah istimewa yogyakarta

INDONESIA